The extraordinary announcement that GPs may no longer be able to sign their patients off work for periods longer than 4 weeks, offers an insight as to corporate involvement which underpins the policy decisions of neoliberal governments. There are doubtless many shades of understanding and levels of cynicism amongst both the supporters and the protagonists of these policies, but there are certainly those who know exactly how to deliberately spin the narrative to achieve the desired financial outcome for the ‘markets’. This post attempts to draw out some of the strands.
Lord Freud, Minister for Welfare Reform, has announced a new way in which this government can potentially deter the disabled and long-term sick from claiming benefits. No longer would the GP be able to sign patients off work for longer than 4 weeks. After that period, the professional expertise of the medic would be subject to an independent assessment, presumably by the highly questionable tick list/points system used by a private contractor such as ATOS. Furthermore, according to a Guardian report People who are signed off sick would also be put on to jobseeker’s allowance, rather than employment support allowance, for a period of three months. They would receive less money and have to prove they were looking for work.
So yet another tranche of ill and disabled people would have to comply with an inappropriately structured assessment with all the attendant worrying, potential exacerbation of symptoms and travel expenses; not to mention additional costs to the tax-payer, that such a superfluous assessment entails.
Labour MP Dennis Skinner said: “Last year, the government said GPs should be accountants in charge of the money that is spent in the NHS. This year they want assessors to be GPs. It’s crazy. No wonder the country is going to the dogs.”
So why are we being told that, on the one hand, the GPs are the right people to determine the spending of billions of tax payer’s money on health commissioning, notwithstanding their lack of expertise, but that they cannot be trusted to use their professional judgement in assessing a patient’s health and/ or the need for a referral to occupational health?
One answer is to ‘follow the money’. The medical profession diagnose some patients with intractable long-term illnesses like Fibromyalgia, Chronic Pain, Lyme Disease, Myalgic Encephalomyelitis (ME), and so on… all of which could prove ruinously expensive for private health providers like the US employment protection insurer Unum.
‘Unum’s 1995 ‘Chronic Fatigue Syndrome Management Plan’ sounded the alarm: ‘Unum stands to lose millions if we do not move quickly to address this increasing problem’
Unum (www.unum.com) is one of the leading providers of employee benefits products and services and the largest provider of group and individual disability income protection insurance in the United States and the United Kingdom.
Unum’s close involvement with Welfare Reform, politicians, psychiatrists, academics and think tanks is well documented, and arguably can be likened to the tentacles of the Goldman Sachs squid extending across European governments. http://think-left.org/2011/11/07/the-market-has-a-name-it-is-goldman-sachs/
Unum’s UK activity since the 1990s is referred to in:
But in addition, Private Eye has also raised questions about Unum’s involvement with the DWP (Department of Work and Pensions).
The Eye first questioned Unum about the possibility of a serious conflict of interest back in 1995… Tricky questions are again being asked about the profits American insurance giant Unum stands to make from its massive media push on income protection cover, promoted as the answer to the latest tough welfare reforms …..
Meanwhile disability activists who have fallen foul, and been forced to appeal cuts in DWP benefits based on flawed Atos assessments, and campaigning groups like Black Triangle, think the whole thing stinks and are urging MPs to investigate.
It is clear that there is a ‘happy match’, a common objective, between the neoliberal political view of benefits, and the interests of private health insurers. The neoliberal politician wants to shrink the State and reduce public expenditure via privatisation, and the private health insurer wants to maximize profitability by not having to pay out for any claims. Both, therefore, want to remove people from benefit entitlement and, to that end, working collaboratively within the DWP would clearly make ‘sense’. Unfortunately, neither the agenda of the politician, nor the health insurer, address or include the actual reality of diverse problems of ill health and the myriad of difficulties faced by sufferers … and as has been described there are several million sufferers of intractable long-term illnesses and permanent disabilities. In effect, the DWP agenda is motivated towards denying ‘illness’ and associated legitimate need, wherever possible.
In order to bridge this gap between the policy makers and reality, a narrative must be constructed which is both compelling and achieves the common objective without it being obvious that the real agenda is privatization and withdrawal of public expenditure. The narrative chosen usually attributes some innate characteristic to a particular group. For example:
‘GPs are our most trusted members of society and know what is best for their patients… therefore they should do healthcare commissioning for the NHS’
‘GPs are too emotionally involved and do not know what is best for their patients … therefore, we need an ‘objective’ assessment.’
However, the underlying assumptions about illness upon which the DWP predicate their actions seem to have slipped out in the following quote:
Justifying the new proposals, UK’s national director for health and work, and the former head of the British chambers of commerce David Frost, said when people were off sick for longer than four weeks they started “to lose the will to work”
Anything more than cursory consideration, indicates that this is a ludicrous and totally unsubstantiated statement. All people become work averse after 4 weeks of being so ill that the GP considers them unfit to go to work? Where is the evidence for such an assertion? It is not even clear how it would be possible to validate such a claim scientifically.
However, this statement is consistent with the biopsychosocial model of illness which needs to be explored more fully in another article. Suffice it to say that this Orwellian model redefines ‘illness’ and was created by ‘psychiatrists and academics … happy to draw on their moral authoritarianism and neo-liberal policy prescriptions (and unmentioned links with Unum) to produce a monograph, The Scientific & Conceptual Basis of Incapacity Benefits (TSO, 2005, Waddell and Aylward) which was published by the DWP, and provides the intellectual framework for the 2006 Welfare Reform Bill (1).
The proposition, “to lose the will to work” amply indicates one of the moral panics of authoritarianism that human beings only behave ‘properly’ if offered ‘the stick or the carrot’… ie. people will pretend to be ill to get out of work if given the opportunity.
This view of humanity or ‘model of man’ underpins both neoliberal policy decisions and the justification for the so-called ‘free-market’. The nature of ‘Man’ is perceived as innately self-interested, greedy, and wanting to ‘pull a fast one’, unless they are restrained by laws or offered incentives. That it is considered to be innate, and therefore immutable, justifies both taking advantage of others to get the best deal, and the imperative to punitively control the other to prevent having that advantage taken away. Hence, we have a one-sided neoliberalism.
‘..neoliberalism has not so much been about increasing wealth, but about redistributing it.
Unsurprisingly, given the lack of fit with reality:
‘The work capability assessment programme, which assesses benefit claimants to see whether they are fit for work is “teetering on the brink of collapse” as the system becomes clogged up with appeals.’
Appeals have quadrupled, and Citizen’s Advice Bureau’s are inundated with people seeking advice on how to appeal.
It is clear that the changes and cuts made to the benefits system are based on the interface of ideological, psychological, political and financial factors, and are simply not tenable. The appalling impact of these ‘welfare reforms’, ungrounded in reality, are only now beginning to come to light with tragic reports of suicides http://diaryofabenefitscrounger.blogspot.com/2011/11/latest-disability-news-roundup.html but little reported in the mainstream media are the increased levels of hardship, worry and deprivation for the disabled and long-term sick whom the overwhelming majority of the population would wish to support.
Somewhat horrifyingly, these facts are used to the advantage of Unum UK in their advertising ploys:
McGarry, chief executive at Unum UK, earlier this year warned: “The government’s welfare reform bill will seek to tighten the gateway to benefits for those people unable to work due to sickness or injury. Each year up to 1m people in the UK become disabled and the reforms mean that working people will be able to rely less on state benefits to maintain the standard of living they were used to prior to their illness.”
So, Unum warns people to get insured against the cuts in benefits … of which they, Unum, were major architects …. either directly as advisory consultants, or through their funding of psychiatrists who created the intellectual framework, the funding of think tanks and academics who in turn recommend policies to the DWP, and by offering ‘jobs for the boys’. For example, by funding the 1.6m UnumProvident Centre for Psychosocial and Disability Research at Cardiff University, and appointing Mansel Aylward (the former DWP Chief Medical Officer and co-author of the DWP biopsychosocial monograph) Director of the unit..
It is hard to believe that there are not some very hard-headed individuals in Unum who are not fully aware of the heist that they have perpetrated.
It should be noted that there are many other private health providers who have doubtless played a similar role in creating Lansley’s new model for the NHS…
However, it cannot be avoided that many of these policies stem from New Labour’s period in office. It is particularly noteworthy that a common link is provided by Lord Freud who switched from New Labour to the Conservatives in 2009, having been appointed by Tony Blair to provide an independent review of the British welfare to work programme in 2006, and then rehired as an adviser to the government when James Purnell was appointed Secretary of State for Work and Pensions in 2008. A former journalist for the FT, Freud became the vice-chairman of investing banking at UBS AG until his retirement in 2003. His expertise in disability or long-term illness is rather notably absent but his background in asset management and financial structures is clearly impressive.
UBS AG (SIX: UBSN, NYSE: UBS) is a Swiss global financial services company headquartered in Basel and Zürich, Switzerland, which provides investment banking, asset management, and wealth management services for private, corporate, and institutional clients worldwide, as well as retail clients in Switzerland. (Wikipedia)
In order to become Real Labour, Ed Miliband and his team must draw a clear line away from New Labour’s policies, and devise a programme of Welfare Reform which is fit for purpose, and which really meets the needs of some of the most vulnerable people in society. The present arrangements should be rejected because they are dangerous, punitive and would be completely unacceptable to most of the population if their true impact was exposed. Philip Gould, one of the architects of New Labour, advised Tony Blair in 1997 to ‘Reassure, reassure, reassure’. Ed Miliband explicitly needs to ‘Reassure, reassure, reassure’ the population of the UK, that they will be appropriately protected and helped if they or their family are, or should find themselves, vulnerable and in need due to long-term illness or disability.